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      Cost-effectiveness of human papillomavirus vaccine in China: a systematic review of modelling studies

      systematic-review

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          Abstract

          Objectives

          China suffers from high burdens of human papillomavirus (HPV) and cervical cancer, whereas the uptake of HPV vaccine remains low. The first Chinese domestic HPV vaccine was released in 2019. However, collective evidence on cost-effectiveness of HPV vaccination in China has yet to be established. We summarised evidence on the cost-effectiveness of HPV vaccine in China.

          Design

          Systematic review and narrative synthesis

          Data sources

          PubMed, EMBASE, China National Knowledge Infrastructure and Wanfang Data were searched through 2 January 2021

          Eligibility criteria for selecting studies

          Cost-effectiveness studies using a modelling approach focusing on HPV vaccination interventions in the setting of China were included for review.

          Data extraction and synthesis

          We extracted information from the selected studies focusing on cost-effectiveness results of various vaccination programmes, key contextual and methodological factors influencing cost-effectiveness estimates and an assessment of study quality.

          Results

          A total of 14 studies were included for review. Considerable heterogeneity was found in terms of the methodologies used, HPV vaccination strategies evaluated and study quality. The reviewed studies generally supported the cost-effectiveness of HPV vaccine in China, although some reached alternative conclusions, particularly when assessed incremental to cervical cancer screening. Cost of vaccination was consistently identified as a key determinant for the cost-effectiveness of HPV vaccination programmes.

          Conclusions

          Implementing HPV vaccination programmes should be complemented with expanded cervical cancer screening, while the release of lower-priced domestic vaccine offers more promising potential for initiating public HPV vaccination programmes. Findings of this study contributes important evidence for policies for cervical cancer prevention in China and methodological implications for future modelling efforts.

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          Most cited references46

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          Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.

          David Moher, Alessandro Liberati, Jennifer Tetzlaff … (2010)
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            Criteria list for assessment of methodological quality of economic evaluations: Consensus on Health Economic Criteria.

            Silvia Evers, Mariëlle E.J.B. Goossens, Henrica de Vet … (2005)
            The aim of the Consensus on Health Economic Criteria (CHEC) project is to develop a criteria list for assessment of the methodological quality of economic evaluations in systematic reviews. The criteria list resulting from this CHEC project should be regarded as a minimum standard. The criteria list has been developed using a Delphi method. Three Delphi rounds were needed to reach consensus. Twenty-three international experts participated in the Delphi panel. The Delphi panel achieved consensus over a generic core set of items for the quality assessment of economic evaluations. Each item of the CHEC-list was formulated as a question that can be answered by yes or no. To standardize the interpretation of the list and facilitate its use, the project team also provided an operationalization of the criteria list items. There was consensus among a group of international experts regarding a core set of items that can be used to assess the quality of economic evaluations in systematic reviews. Using this checklist will make future systematic reviews of economic evaluations more transparent, informative, and comparable. Consequently, researchers and policy-makers might use these systematic reviews more easily. The CHEC-list can be downloaded freely from http://www.beoz.unimaas.nl/chec/.
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              Human papillomavirus vaccine introduction--the first five years.

              L Markowitz, Heather Cubie, Shelley L. Deeks … (2012)
              The availability of prophylactic human papillomavirus (HPV) vaccines has provided powerful tools for primary prevention of cervical cancer and other HPV-associated diseases. Since 2006, the quadrivalent and bivalent vaccines have each been licensed in over 100 countries. By the beginning of 2012, HPV vaccine had been introduced into national immunization programs in at least 40 countries. Australia, the United Kingdom, the United States, and Canada were among the first countries to introduce HPV vaccination. In Europe, the number of countries having introduced vaccine increased from 3 in 2007 to 22 at the beginning of 2012. While all country programs target young adolescent girls, specific target age groups vary as do catch-up recommendations. Different health care systems and infrastructure have resulted in varied implementation strategies, with some countries delivering vaccine in schools and others through health centers or primary care providers. Within the first 5 years after vaccines became available, few low- or middle-income countries had introduced HPV vaccine. The main reason was budgetary constraints due to the high vaccine cost. Bhutan and Rwanda implemented national immunization after receiving vaccine through donation programs in 2010 and 2011, respectively. The GAVI Alliance decision in 2011 to support HPV vaccination should increase implementation in low-income countries. Evaluation of vaccination programs includes monitoring of coverage, safety, and impact. Vaccine safety monitoring is part of routine activities in many countries. Safety evaluations are important and communication about vaccine safety is critical, as events temporally associated with vaccination can be falsely attributed to vaccination. Anti-vaccination efforts, in part related to concerns about safety, have been mounted in several countries. In the 5 years since HPV vaccines were licensed, there have been successes as well as challenges with vaccine introduction and implementation. Further progress is anticipated in the coming years, especially in low- and middle-income countries where the need for vaccine is greatest. This article forms part of a special supplement entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012. Published by Elsevier Ltd.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open
                Journal ID (iso-abbrev): BMJ Open
                Journal ID (hwp): bmjopen
                Journal ID (publisher-id): bmjopen
                Title: BMJ Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2044-6055
                Publication date Collection: 2021
                Publication date (Electronic): 8 December 2021
                Volume: 11
                Issue: 12
                Electronic Location Identifier: e052682
                Affiliations
                [1 ]departmentSchool of Health Economics and Management , Nanjing University of Chinese Medicine , Nanjing, Jiangsu, China
                [2 ]departmentDongfang Hospital , Beijing University of Chinese Medicine , Beijing, China
                [3 ]departmentOffice of Financial Affairs , Chongqing Traditional Chinese Medicine Hospital, Chongqing, China , Chongqing, China
                [4 ]departmentDepartment of Epidemiology , Brown University School of Public Health , Providence, Rhode Island, USA
                [5 ]departmentThe First School of Clinical Medicine , Nanjing University of Chinese Medicine , Nanjing, Jiangsu, China
                Author notes
                [Correspondence to ] Dr Tingting Chen; tingtingchen@ 123456njucm.edu.cn
                Author information
                http://orcid.org/0000-0002-5722-8255
                http://orcid.org/0000-0002-5777-3755
                Article
                Publisher ID: bmjopen-2021-052682
                DOI: 10.1136/bmjopen-2021-052682
                PMC ID: 8655525
                PubMed ID: 34880019
                SO-VID: 2c742d87-9924-4fc7-90e0-684f0dfa7a8d
                Copyright © © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
                License:

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                Date received : 23 April 2021
                Date accepted : 18 November 2021
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100005891, State Administration of Traditional Chinese Medicine of the People's Republic of China;
                Award ID: GZY-GCS-2017-36
                Categories
                Subject: Health Economics
                Subject: 1506
                Subject: 1701
                Series title: Original research
                Custom metadata
                special-feature unlocked

                ScienceOpen disciplines: Medicine
                Keywords: infection control,health economics,health policy,oncology
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: infection control, health economics, health policy, oncology

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